People are by virtue of their assignment location, thrust into professional roles for which they have not been adequately prepared by previous schooling or experience. “Challenges” is designed for all new Indian Health Service [IHS], tribal, and urban dentists within their first three to six months of service. The course provides a basis for understanding and working in the IHS dental programs as well as to establish a baseline of skill and knowledge to be able to provide dental services efficiently and effectively.

Learning Objectives:

Headquarters Session for Challenges [1 hour] The overall goal of the Headquarters session is to explain the mission of the Indian Health Service and the Division of Oral Health, and to provide an organizational framework of how the federal government interacts with Tribal organizations. The teaching resources include PowerPoint presentations and group discussions. Learning Objectives: By the end of this session, participants will be able to: • State the mission of the Indian Health Service • Describe the functions of the Division of Oral Health • Identify how to access clinical issues and career development resources

Dental Public Health Session [3 hours] Dental Public Health is the science and art of preventing and controlling dental diseases, and promoting dental health through organized community efforts. Previous educational or practice experiences may have emphasized how to be successful in the private sector. This session will focus on how to be successful in a dental public health program. This session is designed to give an overview of key dental public health data and concepts; distinctions between public health and private practice models; basic epidemiology principles; critical reading of research; and social and behavioral dimensions of dental disease. The learning format includes interactive PowerPoint presentations, case studies, and small group discussions. Learning Objectives At the end of the dental public health session, participants will be able to: • Describe the differences between a dental public health practice model and a private practice model; • List available resources that describe oral health status in the United States; • Discuss the effects of social and behavioral effects on one dental disease, and develop a scenario where these effects could be seen in an IHS setting; • Categorize common dental procedures in one of the dental levels of care; • Explain the basis of both preventive and periodontal recall management in an IHS dental public health practice. • Distinguish the three current IHS dental GPRA indicators and discuss the rationale behind these indicators. • Explain the goal for the IHS ECC Initiative, and how to access resources to achieve these goals.

Pediatric Dentistry Session for Challenges [8 hours] The overall goal of the pediatric dentistry session is to help the course participant better understand the treatment needs often presented in young children. This session is designed to give an overview of infant oral health and disease; preventive, diagnostic, and restorative strategies; and how to deal with common traumatic injuries. The learning format includes interactive PowerPoint presentations, case studies, and small group discussion. Learning Objectives: By the end of this session, participants will be able to: • Provide anticipatory guidance to parents/guardians as to what is normal development and when bottle, breast, cup, pacifier use is appropriate. • Explain how and why early caries relates to latter caries experience. • Recognize varying degrees of carious involvement, space maintenance needs, behavioral considerations, and when consults [related to co-morbidities] are necessary. • Determine when radiographs are required and what types of radiographs are appropriate for a given age. • Discuss a variety of pulp treatments in primary teeth, medicaments utilized, and rates of success. • Describe common trauma injuries in children, what to evaluate, and when consults are needed. • Distinguish between various types of restorative materials for primary teeth considering their relative longevity and their public health implication. • Recognize developing occlusion, early malocclusions, possible treatment options, and appropriate referrals. • Select behavior modification technique for achieving treatment appropriate with the child’s chronological age and maturity. • Discuss types and dosages of analgesics and local anesthesia appropriate for children. • Explain the logic for when and why general anesthesia may be an appropriate treatment option. • Describe what constitutes special needs patients and how their treatment is approached. • Identify the most common chronic diseases [anemia, asthma] encountered with children in our population and their impact on patient treatment. • Recognize the most common oral pathologies seen in our population and identify what should be treated and what should be referred. • Describe common ages for abuse and neglect, the most common presenting features, and dental provider’s legal responsibility.

Periodontics Session for Challenges [4 hours] The overall goal of the periodontics session is to advance participants knowledge and skills in nonsurgical and surgical periodontics, and to introduce them to public health in periodontics. The format will be lecture, discussion, and case studies. Learning Objectives: At the end of the periodontal session, the participants will be able to: • Record CPI/PSR scores accurately. • Diagnose periodontal diseases. • Plan periodontal treatment taking into account the delivery of care, including the provider [DA, RDH, or DDS/DMD]. • Recommend appropriate antimicrobial agents for brushing, rinsing, local and systemic delivery in the treatment of periodontitis. • Recognize indications and contraindications to periodontal surgery. • Describe inflammation and the relationship between oral and systemic diseases. • List five conditions that put individuals at risk for periodontitis. • List three new technologies in periodontics that can/could be recommended for use in an I/T/U dental program.

Endodontic Session for Challenges [8 hours] The overall goal of the endodontic session is to provide a review of endodontic principles and techniques applied to clinical situations common to Indian Health Service dental practice: diagnosis and treatment of common dental pulp diseases with the emphasis on pulp testing; radiography, anatomy; vital pulp therapy; endodontic access; cleaning and shaping; and placement of medicaments in the pulp space and coronal restoration. Teaching resources include PowerPoint presentations developed by IHS Endodontists based on their experience and the published scientific literature. Laboratory exercise operating on extracted human teeth. Learning Objectives: By the end of the endodontic session, participants will be able to: • Apply the protocol for taking at least two pre-op radiographs made at different angles. • Explain the SLOB rule. • Identify clues to multiple canals. • Perform pulp and periradicular testing • Explain the rationale for making a pulpal and periradicular diagnosis. • Record diagnoses that are consistent with exam findings. • Describe the American Association of Endodontics [AAE] diagnoses. • Locate sources for endodontic information on basic canal anatomy. • Describe the importance of Straight Line Access and how to achieve it. • List techniques to avoid perforations, ledging and blocking. • Explain the importance of magnification and illumination. • Discuss the rationale for working length distinguishing between preparation of the canal and obturation. • Describe the relationship of diagnosis and urgent treatment needed. • Demonstrate hand filing techniques to handle ledges and blocked canals. • Use Balanced Forces Filing technique and placement of CaOH. • Discuss the advantages and disadvantages of temporary filling materials. • Demonstrate the use of gutta percha cones of greater taper. • Evaluate which teeth are restorable. • Discuss rationale for using post retention. • Explain the concept of restore at the time of obturation. • Trauma diagnosis and treatment

Oral Surgery Session of Challenges [8 hours] The overall goal of the oral surgery session is to advance participants’ skills and abilities about surgical procedures by adhering to a set of principles to provide the best possible treatment for patients. The format of this session is lecture, discussions, case studies, simulated practice, and hands-on suturing lab.

Lectures will be presented about how to interview a patient; review medical history; obtain appropriate labs, radiographs; perform a workup to identify and avoid possible complications during and after surgery. Discussions will emphasize talking with the patients about consent forms; explanation of procedures and risks associated with the procedure; possible alternative treatments; answering patient’s questions; documenting process and findings in a patient’s chart. Cases will demonstrate the principles of simple and moderately difficult surgical extractions. The simple dental extraction cases will focus on establishing and maintaining surgical aseptic technique; proper instrumentation and set up, and use of local anesthetics; complications associated with dental extractions [including but not limited to anatomical considerations]; unexpected inter-operative complications with techniques to deal with these complications; and medical considerations that may compromise a successful surgical outcome. The moderately difficult surgical extraction cases will accentuate establishing and maintaining surgical aseptic technique; instrumentation, expected wound healing; appropriate follow-up and referrals. Cases will demonstrate the evaluation of an ectopically positioned tooth with its anatomic considerations to determine the degree of surgical difficulty and surgical approach [i.e. flap design, degree of bone reduction, sectioning technique, delivery, choice of suturing material and techniques]; possible complications and treatment of those complications including but not limited to bleeding, nerve damage, and infections; management of pain with a brief discussion of antibiotics and analgesics. Learning Objectives: At the end of the oral surgery session, participants will be able to: • Describe the principles of patient evaluation and workup for oral surgical procedures. • Establish and maintain surgical aseptic technique. • Explain the principles of simple dental extractions. • Summarize the principles of moderately difficult surgical extractions with consideration of associated hard and soft tissue anatomy and possible complications. Based upon the providers abilities make appropriate referral. • Explain the various suture materials and use. • Demonstrate various suturing techniques in a laboratory setting and explain when these techniques should be used • Document informed consent, treatment plan, and treatment in patient’s chart.

General Dentistry Session for Challenges [5 hours] Session Summary: The goal of the general dentistry session is to introduce the course participant to the provision of general clinical services in an Indian Health Service dental program. This session is designed to give an overview of diagnostic and treatment planning; preventive and restorative therapies; utilization of expanded-function auxiliaries; advantages and disadvantages of working with different dental materials; and strategies for working with medically compromised patients. The learning format includes interactive PowerPoint presentations, case studies, and small group discussions Learning Objectives: At the end of the general dentistry session participants should be able to: • Assign risk for decay, discuss appropriate therapies and recall intervals for individual patients. • Describe factors affecting caries risk. • Describe restorative dentistry strategies and dental auxiliary utilization in a public health clinic and how they differ from a typical private practice setting. • Discuss the pros and cons of commonly used dental materials and bonding systems. • Summarize the caution needed in the treatment of medically compromised patients.

Disclosure Policy:

It is the policy of the Indian Health Service, Division of Oral
Health, that faculty/planners disclose any financial or other relationships with commercial companies whose products may be discussed in the educational activity.
The Indian Health Service, Division of Oral Health, also requires that faculty disclose any unlabeled or investigative use of pharmaceutical products and medical devices.
Images that have been falsified or manipulated to misrepresent treatment outcomes are prohibited.

None of the faculty/planners for this activity has a conflict of interest, and there is no use of unlabeled or investigative pharmaceutical products or medical devices.
No images have been falsified or manipulated to misrepresent treatment outcomes.The educational objectives, content, and selection of educational methods and instructors are conducted
independent of any commercial entity.

Tuition must be paid in full 8 weeks prior to the start date of any course. Request for refunds must be received in writing at
least two weeks before the course begins. For each refund request, there will be an administrative charge of $100. No refunds will be made to registrants who fail to attend a course.
If IHS CDE program cancels a course, then 100% of the tuition will be refunded.